Information Collection

[NCCDPHP] Pilot Testing of State-Level Prevalence Estimation Using a YouGov Internet Panel

IC 260937 under ICR 202301-0920-011 · OMB 0920-1291.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1291 [NCCDPHP] Pilot Testing of State-Level Prevalence Estimation Using a YouGov Internet Panel	Form and Instruction
0920-1291 CDC Questionnaire - BRFSS subset Attachment 1 CDC questionnaire BRFSS subset.docx	Form and Instruction
0920-1291 Panel Core Questions Attachment 2 core questions.docx	Form and Instruction
Attachment 3 consent.docx Consent Statement/Form	IC Document
Attachment 4 YouGov panel recruitment and survey methodology-combined.pdf YouGov Recruitment/Methodology	IC Document
Pilot Testing of State-Level Prevalence Estimation YouGov.docx 0920-1291 GenIC Request Template	IC Document

IC Title:

Agency IC Tracking Number:

0920-1291-23GP

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1291	CDC Questionnaire - BRFSS subset	Attachment 1 CDC questionnaire BRFSS subset.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1291	Panel Core Questions	Attachment 2 core questions.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,200	2,200
Annual IC Time Burden (Hours)	550	550
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Consent Statement/Form	Attachment 3 consent.docx	07/05/2023
YouGov Recruitment/Methodology	Attachment 4 YouGov panel recruitment and survey methodology-combined.pdf	07/05/2023
0920-1291 GenIC Request Template	Pilot Testing of State-Level Prevalence Estimation YouGov.docx	07/05/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.